Business Systems Specialist Sr. - Epic Tapestry at MemorialCare Medical Foundation
Posted in Information Technology 30+ days ago.
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Location: Fountain Valley, California
At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
The Senior Business Systems Specialist will be responsible for providing high level, specialized, application (Epic) expertise and leadership in the analysis, design, deployment and support of critical business functions within MemorialCare's information technology systems portfolio. The Epic application related to this role will include Tapestry.
Senior Business Systems Specialists will apply their expertise to improve business processes and support critical business strategies to seek out opportunities to educate customers in the strategic use of MemorialCare's IT and applications portfolio (Epic Tapestry).
Individuals work closely with both external and internal customers, department colleagues, system vendors, and other stakeholders to define user requirements and provide integrated solutions based upon MemorialCare's standards, and occasionally customized, computer/systems architecture and applications. You will use your expertise to recommend changes in business workflow procedures, operating with considerable latitude for un-reviewed action or direction, while gaining approval for more critical changes with senior IT and departmental management.
In addition to performing advanced technical assignments, you will be responsible for training lower level personnel, planning and supervision of assignments to junior staff in the technical complexities of assigned work.
- A qualified candidate will have experience in the following areas:
- Possess and apply expert knowledge of particular applications/systems with proven certification/competency, i.e. Epic Tapestry.
- An excellent understanding of managed care areas of the healthcare business including Utilization Management, Case Management, AP Claims, Contracts, Benefits, Capitation and Eligibility.
Possess an understanding of Utilization Management processes in a delegated model including authorizations, denials, appeals and regulatory compliance.
- Familiar with CPT codes, diagnosis codes, payment methods including fee schedules, RBRVS, DRGs that support AP Claim payments.
Good understanding of HMO health plan benefits including capitation, carve outs, maximum out-of-pocket expenses, copays, co-insurance, coordination of benefits and familiarity with non-HMO products.
- Must have previous experience with re-engineering and process improvement techniques.
- Bachelor's degree in Computer Science, Information Systems, Business and/or licensed healthcare profession. Advanced degree or equivalent work experience is desirable.
- Minimum 5-years' experience as a senior systems analyst, applications specialist or equivalent business experience in a leadership role managing business applications.
- Excellent analytical and problem-solving skills.
- Excellent communications skills, both verbal and written.
- At least two Epic Certifications in any of the following areas is required: Tapestry Core, Tapestry AP Claims & Contracts, Premium Billing, Benefits Engine, or Bridges.